Elsevier

Ophthalmology

Volume 127, Issue 4, April 2020, Pages 501-510
Ophthalmology

Original article
Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry

Presented as a paper at: American Association for Pediatric Ophthalmology and Strabismus Annual Meeting, March 2019, San Diego, California.
https://doi.org/10.1016/j.ophtha.2019.10.039Get rights and content

Purpose

To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes.

Design

Retrospective case series review at 10 IATS sites.

Participants

The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS.

Methods

Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010.

Main Outcome Measures

Visual acuity (VA), strabismus, adverse events (AEs), and reoperations.

Results

One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1–7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00–1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (≥20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P = 0.037; and smaller cornea: OR, 3.95; P = 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P = 0.023; and smaller cornea: OR, 4.78; P = 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P = 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%).

Conclusions

Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea.

Section snippets

Methods

This study was approved by the institutional review board or ethics review board at all participating institutions (Mayo Clinic, University of Minnesota, Medical University of South Carolina, Harvard University, Indiana University Medical Center, Duke University Medical Center, Cleveland Clinic, Oregon Health and Science University, Baylor College of Medicine and Texas Children’s Hospital, Emory University School of Medicine, Vanderbilt University Medical Center) and complied with the Health

Results

A total of 164 children (311 eyes) with a history of bilateral cataract surgery before 2 years of age and with a surgical date between 2004 and 2010 (the years of the IATS recruitment) were registered into the TAPS by 10 IATS sites. Two of the original 12 IATS clinical sites did not participate because of institutional review board limitations. Both eyes were enrolled in 147 patients. In 17 patients, only 1 eye was enrolled because the cataract surgery on the fellow eye was performed outside of

Discussion

The TAPS is a large registry of unilateral and bilateral cataracts in children undergoing surgery from 1 to 24 months of age.17 Despite the limitations of retrospective data analysis, the TAPS cataract surgery outcome data are informative and important because these procedures were performed by IATS surgeons during the same period as the IATS and provide comparisons that can guide clinical practice. This case series is the first TAPS study on bilateral cataract outcomes and involves children 1

References (44)

  • S.K. McClatchey et al.

    A comparison of the rate of refractive growth in pediatric aphakic and pseudophakic eyes

    Ophthalmology

    (2000)
  • D.A. Plager et al.

    Refractive change in pediatric pseudophakia: 6-year follow-up

    J Cataract Refract Surg

    (2002)
  • O.L. Weisberg et al.

    Strabismus in pediatric pseudophakia

    Ophthalmology

    (2005)
  • A.R. Vasavada et al.

    Five-year postoperative outcomes of bilateral aphakia and pseudophakia in children up to 2 years of age: a randomized clinical trial

    Am J Ophthalmol

    (2018)
  • E.E. Birch et al.

    The critical period for surgical treatment of dense congenital bilateral cataracts

    J AAPOS

    (2009)
  • M.P. Young et al.

    Relationship between the timing of cataract surgery and development of nystagmus in patients with bilateral infantile cataracts

    J AAPOS

    (2012)
  • S.R. Lambert et al.

    Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts?

    J AAPOS

    (2006)
  • E.D. Bothun et al.

    One-year strabismus outcomes in the Infant Aphakia Treatment Study

    Ophthalmology

    (2013)
  • E.D. Bothun et al.

    Strabismus surgery outcomes in the Infant Aphakia Treatment Study (IATS) at age 5 years

    J AAPOS

    (2016)
  • E.D. Bothun et al.

    Sensorimotor outcomes by age 5 years after monocular cataract surgery in the Infant Aphakia Treatment Study (IATS)

    J AAPOS

    (2016)
  • M.E. Wilson et al.

    The Infant Aphakia Treatment Study: evaluation of cataract morphology in eyes with monocular cataracts

    J AAPOS

    (2011)
  • D.G. Morrison et al.

    Infant Aphakia Treatment Study: effects of persistent fetal vasculature on outcome at 1 year of age

    J AAPOS

    (2011)
  • Cited by (0)

    Supplemental material available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): M.E.W.: Financial support – Knights Templar.

    D.K.V.: Financial support – Knights Templar.

    D.A.P.: Financial support – Knights Templar.

    S.F.F.: Financial support – Knights Templar.

    E.I.T.: Financial support – Knights Templar.

    J.S.A.: Financial support – Knights Templar.

    A.R.L.: Financial support – Knights Templar.

    N.C.W.: Financial support – Knights Templar.

    D.M.: Financial support – Knights Templar.

    S.R.L.: Financial support – Knights Templar.

    Supported by the Mayo Clinic, Rochester, Minnesota (CCaTS grant no.: UL1TR000135). The sponsor or funding organization had no role in the design or conduct of this research.

    HUMAN SUBJECTS: The human ethics committees at all participating institutions approved the study (Mayo Clinic, University of Minnesota, Medical University of South Carolina, Harvard University, Indiana University Medical Center, Duke University Medical Center, Cleveland Clinic, Oregon Health and Science University, Baylor College of Medicine and Texas Children’s Hospital, Emory University School of Medicine, Vanderbilt University Medical Center). All research complied with the Health Insurance Portability and Accountability (HIPAA) Act. Data sharing agreements were established between IATS investigator site and the Mayo Clinic. As a retrospective chart review, informed consent was not required by the IRBs.

    No animal subjects were included in this study.

    Author Contributions:

    Conception and design: Bothun, Wilson, Vanderveen, Plager, Freedman, Trivedi, Traboulsi, Anderson, Loh, Yen, Weil, Morrison, Lambert

    Analysis and interpretation: Bothun, Wilson, Vanderveen, Plager, Freedman, Trivedi, Traboulsi, Anderson, Loh, Yen, Weil, Morrison, Lambert

    Data collection: Bothun, Wilson, Vanderveen, Plager, Freedman, Trivedi, Traboulsi, Anderson, Loh, Yen, Weil, Morrison, Lambert

    Obtained funding: Wilson, Vanderveen, Plager, Freedman, Traboulsi, Anderson, Loh, Weil, Morrison, Lambert

    Overall responsibility: Bothun, Wilson, Vanderveen, Plager, Freedman, Trivedi, Traboulsi, Anderson, Loh, Yen, Weil, Morrison, Lambert

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